Question:medium
An 85-year-old patient has carcinoma of the prostate with Gleason score 6 and PSA <8 ng/ml. What is the best management?
An 85-year-old patient has carcinoma of the prostate with Gleason score 6 and PSA <8 ng/ml. What is the best management?
Show Hint
Consider the patient's age and comorbidities in relation to the indolent nature of Gleason 6 prostate cancer.
Updated On: Jun 23, 2026
- TURP
- Radiation
- Radical prostatectomy
- Keep on active surveillance
Show Solution
The Correct Option is D
Solution and Explanation
Clinical scenario analysis: An 85-year-old male with prostate cancer (Gleason 6, PSA $<8$ ng/ml) requires management that accounts for both disease characteristics and patient factors.
Risk stratification:
- Gleason score 6 = low-grade (well to moderately differentiated)
- PSA $<8$ ng/ml = low-risk biochemical marker
- Combined: low-risk localised prostate cancer
Age and life expectancy: At 85 years, expected life expectancy is approximately 5-7 years. Low-risk prostate cancer has a very slow natural history -- the patient is far more likely to die with prostate cancer than from it.
Why active surveillance is correct:
- Radical prostatectomy: major surgical morbidity (incontinence, erectile dysfunction) unacceptable at 85 years
- Radiation: significant side effects (radiation proctitis, cystitis) without survival benefit in this low-risk, elderly group
- TURP: only palliative for obstruction symptoms, not a cancer treatment
- Active surveillance: monitors PSA and clinical status, intervenes only if progression -- optimal risk-benefit ratio
\[\boxed{\text{Answer: D -- Keep on active surveillance}}\]
Risk stratification:
- Gleason score 6 = low-grade (well to moderately differentiated)
- PSA $<8$ ng/ml = low-risk biochemical marker
- Combined: low-risk localised prostate cancer
Age and life expectancy: At 85 years, expected life expectancy is approximately 5-7 years. Low-risk prostate cancer has a very slow natural history -- the patient is far more likely to die with prostate cancer than from it.
Why active surveillance is correct:
- Radical prostatectomy: major surgical morbidity (incontinence, erectile dysfunction) unacceptable at 85 years
- Radiation: significant side effects (radiation proctitis, cystitis) without survival benefit in this low-risk, elderly group
- TURP: only palliative for obstruction symptoms, not a cancer treatment
- Active surveillance: monitors PSA and clinical status, intervenes only if progression -- optimal risk-benefit ratio
\[\boxed{\text{Answer: D -- Keep on active surveillance}}\]
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